by Mike Breslin
Regulated medical waste (RMW) is a far-reaching term that encompasses everything from syringes to prescription drugs, new and used medical supplies to human and animal parts, to laboratory and hospital equipment. That just begins to describe an entire universe of constituent components.
Adding to the scope of this category is the exploding size of the American healthcare market due to the aging of baby boomers, new technologies requiring ever more supplies, the mushrooming use of prescription drugs and the increased generation of home medical waste. For instance, the obesity problem has triggered more use of onset Type 2 diabetic supplies, like blood testing and insulin syringes, leading to a surge in RMW disposal.
RMW is a complex, ultra sensitive branch of the solid waste stream. It is subject to special regulatory compliance depending on where it is generated, comes with legal liabilities throughout the flow of the waste stream and requires higher collection and disposal costs.
Reuse for humanitarian relief
Because of the challenges facing RMW and the desire of the healthcare industry to ensure public safety and to be environmentally responsible, keeping as much of these wastes out of landfills as possible and recycling whenever practical have become high priorities. As a result, there have emerged a number of innovative alternatives.
Over the past decade, for example, the recovery and reuse of medical supplies and biomedical equipment has grown from virtually nothing to a well-established national supply chain that is now exporting hundreds of thousands of tons annually for reuse to developing countries around the world. Materials that would have been landfilled are now relieving pain and saving lives.
An example is MedShare, a non-profit humanitarian organization founded in 1998 and headquartered in Atlanta. It pioneered the concept of recycling American medical supplies and equipment for people in needy countries.
MedShare has established bin collection programs in the Atlanta and San Francisco metro area hospitals to recover medical supplies that otherwise would be trashed due to hospital regulations. “Since our founding we estimate that we have saved in excess of 1.7 million cubic feet from going into landfills. On average, we recover about 2,500 pounds of surplus medical supplies each week from hospitals in Atlanta and Northern California, thus diverting them from landfills,” said A.B. Short, CEO and cofounder of MedShare.
Hospitals generate large volumes of medical waste, much of it perfectly good medical supplies and equipment. This is partially a result of our litigious society. Once an item is ordered for a patient’s room, the patient is charged for it, and if unused, it must be disposed of. There are also hundreds of different medical-surgical kits used. Often there are separately packaged leftovers as well as damaged packaging, inventory clearances and equipment disposals due to upgrades.
MedShare collects these items, as long as the ones with expiration dates have a shelf life of 12 to 18 months, and receives product donations from medical supply manufacturers and distributors – mostly cosmetically damaged products, overstocks and discontinued lines. It also receives products and equipment from other humanitarian organizations that have found MedShare an efficient conduit to distribute their donations.
With a small staff and approximately 1,000 volunteers per month, MedShare sorts and repackages nearly 25,000 product codes, repairs and refurbishes biomedical equipment ranging from hospital beds to X-ray machines and packs 40 foot containers for export.
Thus far they have shipped nearly 600 containers to hospitals and clinics in the developing world valued at more than $70 million dollars, and have provided medical supplies to more than 1,000 international medical missions worth over $2.3 million.
This recycling model has led to the formation of similar non-profit efforts across the country. In 2008, the MedSurplus Network was established. “The MedSurplus Network is a growing alliance of five medical surplus recovery organizations working together to improve the quality of medical supply and equipment donations here and abroad,” Short explained.
Hospitals are enthusiastic about recovery and reuse organizations. Many are actually paying for the collection service. It’s consistent with their humanitarian efforts and green agendas, plus has the bottom-line benefit of reducing RMW volume thereby reducing disposal costs.
The bulk of medical waste is biohazardous. It includes potentially infectious materials such as blood and other biologics, dressings, pharmaceuticals, laboratory waste, and contaminated glassware and sharps – things like needles, syringes and surgical instruments. Virtually any material generated from the medical industry by labs, hospitals, clinics, physicians, dentists, pharmacies and veterinarians can fall into the category of biohazardous.
Laws, regulations, standards and guidelines governing biohazardous materials abound. Many aspects are regulated at the state and local level. Many regulations are based on the United States Environmental Protection Agency’s (EPA) Model Guidelines for State Medical Waste Management. Others are governed by federal regulations issued by the EPA, the Occupational Safety and Health Administration (OSHA), the Department of Transportation (DOT) and United States Postal Service (USPS). The federal government also regulates hazardous elements used in medicine such as mercury and radioactive elements. The EPA’s Medical Waste Tracking Act has established guidelines for the segregation, handling, containment, labeling and transport of medical waste. Most states have developed their medical waste regulatory framework around these guidelines.
In the old days, most hospitals used on-site incinerators to dispose of medical wastes, but for the most part those times have passed due to the Clean Air Act, the costs for pollution control systems and the poor environmental image of smoke. Today, hospitals and healthcare practitioners send RMW out to private companies for disposal.
According to the EPA, currently over 90 percent of potentially infectious medical waste is incinerated, but this used to emit highly toxic pollutants like acid gases, carbon monoxide and nitrogen oxides, and are major sources of dioxins and metals such as lead, mercury and cadmium. This caused public opposition to medical waste incineration and many healthcare facilities looked for more environmentally friendly alternatives, primarily industrial sized autoclaves using steam sterilization and often combined with post-processing shredding, microwaving or chemical treatment. Once properly sterilized and shredded, if so required to meet local landfill regulations, RMW can be landfilled as non-hazardous.
Costs for medical waste disposal are much higher than regular solid waste because of the special handling mandated by regulations and the extra treatment required. Like many services, the costs go down as the volume generated goes up. Competition among service providers level out prices of disposal. Medical waste disposal companies are reluctant to talk about costs because it largely depends on volume and nature of the collection customer; frequency and distance for pickup, or if delivered by mail.
But that leaves the perplexing question of how much more does it cost to dispose of biohazardous medical waste than regular solid waste. The only extensive study found on this issue was conducted by Frost and Sullivan, a respected international research and consulting firm. Published in November 2004, ‘U.S. Medical Waste Management and Disposal Markets’ said in part: “…the cost of disposing medical waste is currently over $480 per ton, compared to municipal waste at a cost of around $24 per ton.”
American Recycler spoke to George Winters, manager of marketing and corporate communications for XMED Medical Waste Disposal about typical biomedical collection and disposal practices. Headquartered in Huntsville, Alabama, XMED uses a fleet of trucks to make regular collections of biohazardous waste at hospitals and clinics throughout North Alabama and Southern Tennessee, and has a nationwide mail-back program.
Like most, XMED provides services to anyone who generates sharps or regulated medical waste – from large hospitals to tattoo parlors. Hospitals use small autoclaves to sterilize reusable instruments, but all other contaminated materials must be put in approved biohazard containers.
“We charge by the container, generally 28 or 32 gallon plastic-rubberized containers. Inside the container is a red biohazard bag that must be tied up and the container sealed before pickup,” said Winters.
Smaller containers are used with XMED’s mail-back program – three smaller sized packages for sharps disposal and a five gallon container for regulated medical waste. Biohazardous materials must be mailed in a puncture proof container that is sealed inside a 4 mil plastic liner to meet USPS and DOT regulations.
Materials arriving at XMED’s facility go to industrial autoclaves that handle hundreds of pounds of material and are sterilized using high pressure steam. Sterilized materials are compacted and disposed of according to state and federal regulations.
“We are very environmentally and regulatory compliant in our activities and make sure our process is clean. When we send containers back they are cleaned and sanitized because our customers want it that way,” Winters concluded.
A mobile solution?
American Recycler also spoke with Nicholas Esposito, director of marketing for MedClean Technologies, headquartered in Bethel, Connecticut. Although his company outfits treatment facilities and provides custom built solutions for its customers, MedClean has developed a patent-pending, mobile, self-contained approach for regulated medical waste sterilization and volume reduction.
“To my knowledge, we are the only company offering a mobile or stationary self-contained unit that utilizes autoclave and shredding technology with all utilities on board. It has the ability to be a disaster relief unit because it is self-contained and delivered on demand. With steam and electricity already onboard, the only additional requirement is a simple garden hose, he explained.
The MedClean system uses an onboard steam sterilization unit followed by a separate inline shredder that reduces sharps down to one eighth of an inch size, and red bags to confetti. Once processed, it can go into municipal solid waste dumpsters as non-hazardous.
“The costs associated with operating a MedClean system is under a penny per pound. The total cost to a hospital will depend on the volume of medical waste being addressed. Further, the MedClean System can be acquired as a lease, purchase or rental with no capital outlay. The biggest cost-reduction comes with the ability to address multiple waste streams onsite; red bags, sharps, and confidential documents, with a MedClean System,” said Esposito.
It has not escaped the attention of scientists, engineers and entrepreneurs that medical waste is a potentially rich source of chemicals that can be converted into fuels and a wide range of other chemicals. It’s a sound concept: medical waste is totally destroyed, and the energy content is recovered and converted into a synthetic gas which can be reformulated into any number of chemical derivatives such as ethanol. A number of companies are following this path with various technologies, but the volume being processed today is very minimal.
Last year a major development occurred – a joint venture called S4 Energy Solutions was formed between Waste Management, Inc. and InEnTec LLC to develop and operate a series of plasma gasification plants. Initially, the facilities will process medical and industrial waste streams.
Education must begin at home
While collection practices and disposal methods differ, the healthcare industry appears to do a good job of disposing of medical waste driven by regulations, liability issues and professional responsibility. The industry is trending away from incineration to autoclaves.
In most states, however, home generated medical waste is not regulated. This does not apply to regulated medical waste produced by home healthcare workers such as visiting physicians, nurses, therapists or aides. They are supposed to provide for proper disposal.
Home medical waste created through the personal administration of injectable medications, other invasive or noninvasive procedures and surplus or expired prescription drugs are handled differently depending on jurisdiction.
Many counties and municipalities recommend that sharps and other materials be put into a heavy plastic container, closed with a top, sealed with tape, be clearly marked as hazardous medical wastes and put into household trash. This protects waste handlers and segregates hazardous material for incineration or sterilization. Other communities have designated drop off locations or special pick up days.
The sad truth, though, is that far too much medical waste is improperly comingled with household trash, either through laziness or because communities have failed to provide adequate consumer education and convenient means for disposal.
These materials pose serious safety, health and environmental problems. For example, over four billion prescriptions are written annually in the United States. Up to 40 percent dispensed outside hospitals go unused, generating approximately 200 million pounds of pharmaceutical waste each year. Much of this waste goes into sewer systems contaminating water supplies or in landfills doing the same. People often flush disposable syringes down toilets. Because they float, they are difficult to remove at the wastewater treatment plants and can wind up in rivers, the oceans and wash up on beaches.
In fact, it was medical waste washing up on East Coast beaches that first prompted Congress to enact the Medical Waste Tracking Act in 1988. This landmark legislation eventually led to the comprehensive federal and state regulations in place today.